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Purpose After cataract phacoemulsification surgery, spherical equivalent refraction (SER) may be affected by factors including corneal curvature, effective lens position and axial length. While refractive outcomes have been assessed in the immediate post-operative period, longer-term changes in refraction have not been reported. The purpose of this study was to investigate the timeline changes in refraction after cataract surgery over a period of 3 years. Methods This was a retrospective observational study that included 344 eyes of 204 patients who underwent cataract emulsification surgery between 1 January and 31 December 2018 at two private hospitals. Keratometry, anterior chamber depth (ACD), central corneal thickness (CCT) and axial length were measured at baseline and post-operatively at 1 month, 1 year, 2 years and 3 years. Changes in SER and ocular parameters were assessed at each post-operative timepoint. Results Between 1 month and 3 years post-operatively, an overall myopic shift (0.32 ± 0.21 D, p p p = 0.04) and CCT (p Conclusion The 3-year timeline changes in SER after cataract surgery were evaluated. As hypermetropic shift was the most common refractive change observed, it may be beneficial to aim for a more myopic post-operative refraction target. Patients should be advised of the potential for refractive changes after surgery.

To evaluate factors that may influence the direction and extent of long-term refractive error after cataract surgery.This was a retrospective observational study conducted across two private practices in Sydney, NSW, Australia. The study population consisted of patients who underwent cataract phacoemulsification surgery between January 1 and December 31, 2018. Patients who received cataract surgery combined with another procedure were excluded. Demographic and biometric data including anterior chamber depth (ACD), keratometry, central corneal thickness, axial length (AL) and lens thickness were obtained pre-operatively. Spherical equivalent (SEQ) refraction was measured at 2 months and 3 years after surgery and compared with target refraction. Factors associated with refractive error were analyzed.This study included 221 eyes of 122 patients. A refractive error within 1.00 D was achieved in 217 eyes (98.2%) at 3 years post-operatively. Mean prediction error decreased significantly between 2 months and 3 years after surgery irrespective of whether eyes were more myopic (p 0.001) or more hypermetropic than predicted (p .0001). Pre-operative ACD and ACD-to-AL ratio were significantly associated with SEQ prediction error.After cataract surgery, refractive outcomes may be influenced by ACD and ACD-to-AL ratio. The pre-operative assessment of these risk factors may better inform IOL selection in individual patients. Prospective studies in a larger cohort are required.